Avastin combined with chemotherapy has improved the survival of some lung cancer patients. Avastin plus folfox has improved survival for some colon cancer patients. Avastin plus chemotherapy improves the survival of some breast cancer patients. The problem is that it doesn't improve the survival of all cancer patients.

Roche has reported that women with breast cancer who were treated with Avastin in combination with chemotherapy followed by the continued use of single-agent Avastin demonstrated a significant improvement in progression-free survival. It's unclear if Avastin can help increase the overall survival rate in this indication.

I remember a clinical oncologist involved with real-time studies under real-world conditions of drugs like Avastin, telling me when the FDA rules on the clinical utility of a drug, they use a broad-brush approach that looks at the global outcomes of all patients, determining whether these glacial trends reflect a true climate change.

The problem is that while Bethesda, Maryland may not be noticing significant changes in ocean levels, people who live on the Maldives are having a very different experience. As these scientists ponder the significance of Avastin, some cancer patients are missing out on a treatment that could quite possibly save their lives.

One breast cancer patient's life saving therapy is another's pulmonary embolism without clinical benefit. Until such time as cancer patients are selected for therapies predicated upon their own unique biology, we will confront one Avastin after another.

The solution to this problem is to investigate the VEGF targeting agents in each individual patient's tissue culture, alone and in combination with other drugs, to gauge the likelihood that vascular targeting will favorably influence each patient's outcome.

12:50 pm June 27, 2011

Cynic wrote :

I agree that cancer policy is tough to set using a broad brush. However, I don’t see drug companies rushing to help define appropriate sub-populations. Why limit your market by identifying a target subset when you can sell product to a whole pool of people? Hope is very profitable.

We have far too few targeted drugs like Herceptins out there (though, if memory serves correctly, Herceptin was only targeted to a sub-population after it became clear that it wouldn’t receive broader FDA approval). I know that you cannot magically define a perfect sub-population, but I’d love to see drug companies actually have a financial incentive to find the right patients, rather than to sell to as broad a population as possible.

4:18 pm June 27, 2011

Mom has lung cancer wrote :

I read this article in the Journal while waiting for the oncologist with my mother. I asked for his thoughts. He said that it was very irritating to have the FDA remove a treatment that in some cases saves lives. He also said that he does not continue with any treatment that is not working, obviously. So the cost issue is really moot. He also said that the side effects did not occur anywhere near or to the degree that is being reported. I would much rather have my doctor decide on my course of treatment than a panel of people that could not get a job in the private sector.

12:02 pm August 18, 2011

Janaye wrote :

Unbelievable how well-written and inrfomavtie this was.

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